INSTALACION DE COLLAR STOP Y PISTÓN.

The quality and quantity of research relating to the screening, assessment and treatment of DWI offenders is insufficient and/or inaccessible to allow practitioners to:

a) identify and select reliable and accurate instruments that can identify and diagnose offenders with substance abuse issues;

b) ascertain which interventions or strategies are most appropriate to apply to this group; and,

c) select appropriate measures of effectiveness by which to evaluate success.

5.2.1 Methodological weaknesses.

Research on screening, assessment or treatment interventions has suffered from a variety of methodological weaknesses. These may include poor research design, unclear or varying definitions of research concepts (e.g., “risk”), inconsistent measure of variables, small sample sizes, and insufficient statistical calculations (Wells-Parker et al. 1995). More importantly, few studies have been conducted specifically on DWI populations and have often included a much broader category of substance abusing offenders.

The way in which the success or effectiveness of treatment is measured also varies across studies. Mostly studies have examined effectiveness in terms of recidivism, however the impact of treatment on other areas is unknown (e.g., employment, family relationships, stable living environment, health).

Also of concern, there have been no longitudinal or cohort studies to identify under what conditions long-term risk reduction may be achieved, or a meta-analysis of screening, assessment or treatment interventions that demonstrates a clear convergence of the research evidence to guide decision-making among practitioners. In addition, the considerable variations regarding how interventions have been defined and measured have made comparisons across studies difficult.

Finally, there is considerable confusion in the research literature with regard to screening, assessment and treatment. Historically, these strategies have been separate components, however, in recent years there is a considerable blurring in the research literature, particularly with screening and assessment and these terms can be used interchangeably, resulting in confusion for lay persons. For example, many screening instruments are actually assessment tools. This blurring also occurs in practice. In many jurisdictions, screening is assessment, and the assessment process is bypassed entirely.

5.2.2 Validation of instruments.

Many screening and assessment instruments have not been validated on a DWI population. At best, most instruments are predictive of alcohol use among a general offender population, but few, if any, are predictive of DWI recidivism. This important gap in the literature makes it difficult for practitioners to identify those offenders in need of intervention and those offenders at high-risk for re-offending. As mentioned previously, even among convicted offenders, the “best” assessments are currently able to detect less than 70 percent of recidivists (i.e., sensitivity) and less than 40 percent of non-recidivists (i.e., specificity; Anderson et al. 2000; Chang et al. 2002). Of greater concern, few instruments have been validated in a natural or real world setting.

5.2.3 Treatment matching.

Treatment matching involves matching offender characteristics to suitable treatment programs and services that will best address their needs, and offenders may be matched to more than one treatment intervention. Research has demonstrated that this is a key principle of treatment intervention and, as such, NIDA recommends that it is important to tailor treatment services to fit the needs of offenders (NIDA 2006).

While there is a belief among practitioners that matching offenders to relevant programs can be an effective process and there is a desire to rely on this strategy, the research literature in this area lacks clarity, making it difficult for practitioners to determine what programs to apply to which offenders. Indeed, “matching individuals to effective interventions – based on personal characteristics, problems and risk factors – has been a major though elusive goal…” (Wells-Parker and Williams 2002, p.665). Of greater importance, most treatment-matching studies have not focused specifically on impaired driving offenders and instead focused more broadly on offenders with drinking problems.

11_{This report is currently being revised and updated. For more information please see} http://www.asam.org/PatientPlacementCriteria.html

Matching also hinges heavily on the quality of the screening and assessment process and there are significant information gaps relating to what treatment programs are effective and with whom. Generally, the research provides limited guidance to allow practitioners to successfully match offenders to appropriate programs and more research is needed in this area. And when effective and appropriate programs are available, it may be difficult for agencies to maintain fidelity which can compromise effectiveness. In the interim, there is research to suggest, and some practitioners believe, that requiring offenders to participate in inappropriate programs can be more damaging (Gendreau and Goggin 1997; McGuire 2001; 2002; Brusman Lovins et al. 2007).

More recently, in the field of matching offenders to interventions, experimental research has been done to examine the risk principle in drug courts. This research has determined that those offenders who pose a higher risk have better outcomes when court appearances are scheduled more frequently, whereas the frequency of appearance had no impact on the outcomes with lower risk offenders (Marlowe et al. 2006; 2008).

Those persons seeking more information about treatment matching should consult the American Society of Addiction Medicine (ASAM) for their published guidelines regarding placement and treatment matching (ASAM Patient Placement Criteria for the Treatment of Substance-Related Disorders 200111_{). In addition, the American} Psychiatric Association (APA12_{) has also published guidelines for the treatment of} substance use disorders which also address the issue of placement in various treatment settings (Kleber et al. 2007).